The efficacy of psychological interventions on psoriasis treatment: a systematic review and meta-analysis of randomized controlled trials

The bidirectional causal association between psoriasis and psychological illnesses: a 2-sample Mendelian randomization study

There have been reports of association between psoriasis and psychological illnesses. Nevertheless, it is not easy to draw conclusions with high quality causality from conventional observational studies. The objective of this study was to evaluate the causality of psoriasis and psychological illnesses. All summary-level data from genome-wide association studies for psoriasis and psychological illnesses were collected from Neale Lab and MRC Integrative Epidemiology Unit. Bidirectional Mendelian randomization analysis was performed to determine the random orientation with an independent genetic variation. The main estimated effects are derived using Inverse-Variance Weighted, weighted median, and MR Egger methods. Multiple data sets were validated against each other, and a series of sensitivity studies were conducted to ensure the reliability of the results. Mendelian randomization analysis revealed a causal effect of psoriasis [odds ratio (OR) 1·34, 95% confidence interval (CI) 1·21-1·46, P < 0.001; and OR 1.28, CI 1.17-1.39, P < 0.001] on psychological illnesses, and vice versa (OR 1.23, CI 1.14-1.31, P < 0.001; and OR 1.21, CI 1.11-1.31, P < 0.001). The results were supported by a series of sensitivity analyses. The findings of this Mendelian randomization study support a causal effect between psoriasis and psychological illnesses, and vice versa.

Non-pharmacological interventions for patients with psoriasis: a scoping review

OBJECTIVES

Healthcare ultimately aims to eradicate diseases and restore normality to people's lives. However, until this is achieved for every person, there is a need to support and assist patients with psoriasis using non-pharmacological interventions. These 'adjuvant' approaches have received little attention, whereas dermatologists and researchers strive for better pharmacological therapy. Here, we aimed to perform a scoping review to identify and catalogue non-pharmacological interventions for patients with psoriasis.

DESIGN

A scoping review.

SETTING

All healthcare settings.

SEARCH STRATEGY

EMBASE, PubMed, CINAHL, PsycINFO and Scopus databases were searched from their inception to June 2022. Irrespective of the study type, the studies included non-pharmacological interventions for patients with psoriasis. This theme was extracted from the included articles. Two reviewers independently screened and analysed the data.

RESULTS

From 1322 initial records, 71 studies were identified and analysed. Non-pharmacological interventions for patients with psoriasis include two levels: organisational and individual. The organisational non-pharmacological interventions included the nationwide healthcare model (PsPSP, ProvenCare, German PsoHealth and Psoriasis Network, IMPROVE model and PsoWell clinic), innovative teledermatology models (mHealth app, electronic Targeted Intervention for Psoriasis study and therapist-guided internet-based cognitive and behavioural treatments) and multidisciplinary interventions. The individual non-pharmacological interventions included educational interventions (therapeutic patient education, psychoeducational intervention and self-management education), psychosocial interventions (cognitive and behavioural treatments, self-help and peer-to-peer support programmes) and others (happify and motivational interviewing-based training).

CONCLUSIONS

Based on previous literature, a nationwide healthcare model protocol was constructed for patients with psoriasis. This provided the direction for developing a new psoriasis healthcare model and a basis for summarising the non-pharmacological interventions for patients with psoriasis, which helps them adjust to changes in the skin disease.

Psychological Well-Being of Adult Psoriasis Patients: A Narrative Review

Psoriasis is a chronic systemic inflammatory condition, and psychiatric comorbidities are common in this condition. It is a non-communicable, autoimmune, and incurable disease. Psoriasis causes an adverse effect and is connected with various psychological symptoms like social isolation, guilt, and embarrassment of a patient. They decrease self-esteem because of depression, anxiety, stress, and substance abuse adults. The prevalence rate of adults is gradually increasing. This study uses various scales to evaluate the level of psoriasis. This study aims to evaluate the level of depression, anxiety, stress, and substance abuse among adult psoriasis patients and to identify the factors affecting psoriasis patients. A detailed search was carried out using essential databases such as PubMed, Google Scholar, and the World Health Organization (WHO) database to search for articles elucidating the same. In total articles, 36 out of 160 are selected. All studies found that psoriasis is at a positive level in that the level of depression and anxiety is moderate to severe, the level of stress is moderate, the level of alcohol abuse is higher, and the level of smoking consumption is ever-increasing. A severe skin condition that impacts the quality of life and psychological health. It has become a public health issue. All the selected articles assessed patients who were highly affected by depression, anxiety, stress, and abuse. They also assessed the various comorbidities related to psoriasis.

Zugang und Inanspruchnahme psychosomatischer Versorgung aus ärztlicher Sicht: Eine qualitative Interviewstudie

Hintergrund Chronisch entzündliche Hauterkrankungen sind häufig mit psychosozialen Beeinträchtigungen und einer reduzierten Lebensqualität vergesellschaftet. Ziel dieser Studie war es zu erfassen, wie spezialisiertes medizinisches Personal eines universitären Haut-Entzündungszentrums die Zugangswege und die Inanspruchnahme psychosomatischer Sondierungsgespräche oder Kurzzeitinterventionen bei PatientInnen mit chronisch entzündlichen Hauterkrankungen wahrnimmt.

Methoden Es wurden qualitative Erhebungen in Form von 10 Einzelinterviews mit medizinischem Personal durchgeführt, das zum Zeitpunkt der Befragung im Zentrum für entzündliche Hauterkrankungen der Uni-Hautklinik tätig war. Die Daten wurden inhaltsanalytisch mithilfe einer qualitativen Analysesoftware ausgewertet.

Ergebnisse Die Ergebnisse aus den geführten Einzelinterviews ergaben, dass die Einbindung einer psychosomatischen Versorgung innerhalb eines dermatologischen Entzündungszentrums vom ärztlichen Personal als durchweg positiv bewertet wurde. Die Option auf ein zeit- und zentrumsnahes Gesprächsangebot nimmt dabei eine besondere Rolle ein. Experten fühlen sich mit der ortsnahen Einbindung psychosomatischer Expertise sicherer im Umgang mit belasteten Patient*innen. Der holistische Ansatz scheint einen positiven Einfluss auf die individuelle Behandlung und die Beziehungsgestaltung mit den Patient*innen zu nehmen. Dabei zeigten sich keine wesentlichen Unterschiede im Geschlecht und über verschiedene Altersgruppen hinweg.

Diskussion Die Möglichkeit zur zentrumsnahen Anbindung von belasteten Patient*innen in Form von zusätzlichen psychosomatischen Sondierungsgesprächen wie auch dem Einsatz von adaptierten Kurzzeitinterventionen trägt zur holistischen Behandlung bei, scheint einen günstigen Einfluss auf den somatischen Behandlungsverlauf zu nehmen und unterstützt Ärzt*innen in ihrer Behandlung.

A digital therapeutic for management of psychosocial aspects of psoriasis: A pre‐post proof of concept study

Background

Despite the psychosocial challenges of living with psoriasis many patients may not be able to access appropriate services to manage these challenges. Mobile health interventions may be helpful as a means to support patients in managing the impact of their condition.

Objective

To conduct a preliminary examination of the feasibility and acceptability of a bespoke psoriasis‐specific digital therapeutic solution (hereafter termed Allay), and to provide initial data on psychological changes pre‐post.

Methods

Phase one proof of concept pre‐post study. Eligible patients were provided with Allay on their smartphone and assessed at baseline and at 12 weeks on a range of indices of well‐being. Participants experiences on usability were collected by telephone interview at 4 weeks, 8 and 12 weeks.

Results

Out of 66 participants recruited, 59 persisted in using Allay after the familiarisation phase, and 34 participants completed the 12 weeks programme. Participants showed a statistically significant improvement between induction and the end of the 12 weeks programme on Quality of life, Resilience, Perceptions of ‘Overall impact’ of psoriasis, and ‘Emotional impact’. There was a significant change over the course of using Allay for symptoms of depression but not anxiety. While there was an interaction effect of changes in severity of psoriasis symptoms over the course of the study for dermatology‐specific measures, there was no interaction between such changes in psoriasis symptoms and changes in depression, resilience or beliefs in emotional impact.

Conclusions

Study results suggest that the use of Allay as an adjunct to medical management of psoriasis may help patients improve resilience, mood, beliefs about their condition and enhance their quality of life. Given that this is a phase one proof of concept study, and our rates of attrition further research is necessary to examine comparative effectiveness and stability of these findings.

Relationship between Immune Cells, Depression, Stress, and Psoriasis: Could the Use of Natural Products Be Helpful?

Psoriasis is one of the most widespread chronic inflammatory skin diseases, affecting about 2%-3% of the worldwide adult population. The pathogenesis of this disease is quite complex, but an interaction between genetic and environmental factors has been recognized with an essential modulation of inflammatory and immune responses in affected patients. Psoriatic plaques generally represent the clinical psoriatic feature resulting from an abnormal proliferation and differentiation of keratinocytes, which cause dermal hyperplasia, skin infiltration of immune cells, and increased capillarity. Some scientific pieces of evidence have reported that psychological stress may play a key role in psoriasis, and the disease itself may cause stress conditions in patients, thus reproducing a vicious cycle. The present review aims at examining immune cell involvement in psoriasis and the relationship of depression and stress in its pathogenesis and development. In addition, this review contains a focus on the possible use of natural products, thus pointing out their mechanism of action in order to counteract clinical and psychological symptoms.

Efficacy of psychological intervention for patients with psoriasis vulgaris: a prospective study

Objective

The study aim was to examine the effect of a psychological intervention on patients with psoriasis vulgaris.

Methods

Participants in this prospective study were 205 patients with psoriasis vulgaris, 104 who received a psychological intervention (study group) and 101 who received routine nursing care (control group). An additional 291 healthy subjects formed a non-psoriasis group. The Symptom Checklist-90 (SCL-90), Generic Quality of Life Inventory (GQOLI), Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were used to evaluate psychological status and quality of life.

Results

There were significant differences in SCL-90 and GQOLI scores between the study and non-psoriasis groups. After treatment, the study group showed significantly improved scores on the SCL-90 and GQOLI compared with the control group. Scores on the SDS (mean ± standard deviation: 31.99 ± 4.54 vs. 44.08 ± 4.52) and SAS (28.36 ± 4.52 vs. 40.14 ± 6.33) were improved in the study group. In addition, patients in the study group showed higher satisfaction rate and compliance rate than those in the control group.

Conclusion

Psychological intervention may be beneficial for improving quality of life and the therapeutic efficacy of drugs in patients with psoriasis.

Patient-Centered Care in Psoriatic Arthritis-A Perspective on Inflammation, Disease Activity, and Psychosocial Factors

Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy characterized by skin lesions, dactylitis, and enthesitis. Patients with PsA suffer from a variety of psychosocial difficulties and nonspecific symptoms early on in the disease course and continue to experience progressive disease due to delays in diagnosis and treatment. Symptoms initially viewed as somatization could lead to undertreatment and promote psychological distress, poor coping, and negative patient-provider relationships. Pain and fatigue are important complaints that affect the patient's perception and may need to be addressed with a multidisciplinary approach. Maladaptive cognitive responses can lead to a negative illness perception and impact patient beliefs and concerns over treatment, as well as nonadherence. An underlying inflammatory component in affective disorders has been examined, though whether and how it may interact mechanistically in PsA warrants interest. Cognitive behavioral therapy represents a nonpharmacological treatment modality that can be combined with cytokine-targeted therapy to address both somatic and psychological complaints. Future directions for research include: (1) Elucidating nonspecific manifestations (e.g., subclinical stage, differential with functional syndromes) of PsA and how they impact diagnosis and management; (2) characterizing immune-mediated components of mood disorders in PsA; and (3) whether a bidirectional approach with abrogating inflammation and psychotherapeutic support leads to improved outcomes.

A systematic review of cognitive and behavioral treatments for individuals with psoriasis

Background: Although there are effective dermatological treatments for psoriasis, a proportion of individuals also experience psychological distress not addressed by these treatments. Psychological factors may be targeted by cognitive behavioral therapy (CBT) which may in turn also decrease psoriasis severity.Method: A systematic review using PsycINFO, PubMed, and SCOPUS databases was performed in 2019 to examine the efficacy of treatments that delivered psychotherapy with a major cognitive/behavioral component to patients with psoriasis. Quality of included studies was assessed.Results: Nine randomized controlled trials with 8 unique samples met inclusion criteria. Study quality ranged from fair to good. Half of the studies found improved psoriasis severity following treatment. Several studies found improvements following treatment in anxiety, depression, and stress. The studies that reported non-significant findings on psychological outcomes had samples with healthy baseline psychological functioning. Nearly all studies that examined quality of life as an outcome found improvements following treatment.Conclusion: CBT as an adjunct to conventional dermatological treatments may be particularly beneficial for individuals with more severe pretreatment psychopathology in improving psoriasis severity, anxiety, and depression symptoms. CBT appears to be generally effective in improving quality of life. Greater methodological rigor is needed in future research.